Report on the National Patient Choice Survey - December 2008 England Report on the National Patient Choice Survey - December 2008 England

Prepared by Sheila Dixon, Department of Health May 2009 | **Policy** | Estates\
| HR/Workforce | Performance\
| Management | IM & T\
| Planning | Finance\
| Clinical | Partnership working\
| **Document** | Statistical publication\
| **ROCR ref:** | n/a\
| **Gateway ref:** | n/a\
| **Title:** | Report on the National Patient Choice Survey - December 2008 England\
| **Author:** | Sheila Dixon\
| **Publication** | May 2009\
| **Target** | Public and NHS\
| **Circulation list:** | On-line publication only\
| **Description:** | Statistical publication of the results of the National Patient Choice survey for referrals made in December 2008.\
| **Cross ref:** | http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Statistics/DH_094013\
| **Superseded docs:** | n/a\
| **Action required:** | n/a\
| **Timing:** | May 2009\
| **Contact details:** | Sheila.Dixon@dh.gsi.gov.uk\
| **For recipient's use:** |

© Crown copyright 2009\
First published May 2009

Published to DH website, in electronic PDF format only.\
http://www.dh.gov.uk/en/Publicationsandstatistics Contents

Results of the National Patient Choice Survey – December 2008 England........ 7 Introduction ........................................................................................................... 7 Key findings ......................................................................................................... 7 Choice of hospital ............................................................................................... 8 Awareness of choice ............................................................................................ 8 Going to the hospital of choice .......................................................................... 9 Sources of information on choice ....................................................................... 9 Factors influencing choice .................................................................................. 10 Booking the first appointment .......................................................................... 10 Waiting for the first appointment ....................................................................... 11 Results by type of provider ................................................................................ 11 Variation by SHA ............................................................................................... 11 Variation by PCT ............................................................................................... 13

Annex A: Tables of results of the National Patient Choice Survey - December 2008 England ........................................................................................................ 15 Table A.1 Patients aware of choice, discussing choice and offered choice, December 2008. ........................................................................................................ 15 Table A.2 Patients aware of choice, offered choice and able to go to the hospital they wanted, surveys to date ........................................................................ 16 Table A.3 Patient going where wanted, booking and satisfaction with wait, December 2008. ........................................................................................................ 17 Table A.4 Sources of information used for choosing a hospital, December 2008. ........................................................................................................ 17 Table A.5 Factors when choosing a hospital, December 2008. ......................... 18 Table A.6 Patient responses by type of provider, December 2008 .................... 18 Table A.7 Patients aware of choice, offered choice and going to the hospital they wanted by PCT, December 2008. ................................................................. 19 Table A.8 Number and percentage of PCTs by percentage of patients offered choice, surveys to date. .................................................................................. 22 Table A.9 Percentage of patients offered choice by SHA, surveys to date ......... 22 Table A.10 Percentage of patients aware of choice by SHA, surveys to date ....... 23

Annex B: Notes on the survey methodology .................................................... 24 Background ......................................................................................................... 24 Methodology ....................................................................................................... 24 Response ............................................................................................................. 25 Weighting for non-response .............................................................................. 25 Analysis by age, sex and ethnic group ............................................................... 26 Issues for PCT results ........................................................................................ 26

Annex C: Survey questionnaire ......................................................................... 27

Annex D: Combined survey results by age, sex and ethnic group.................. 29 Background ......................................................................................................... 29 Age and sex results ............................................................................................ 29 Ethnic group results ........................................................................................... 31 Table D.1 Percentage of patients aware of choice by age, sex and ethnic group, surveys to date ................................................................. 33 Table D.2 Percentage of patients offered choice by age, sex and ethnic group, surveys to date ................................................................. 34 Table D.3 Percentage of patients able to go where they wanted by age, sex and ethnic group, surveys to date ................................................................. 35 Results of the National Patient Choice Survey – December 2008 England.

Introduction Since January 2006, all eligible patients referred by their GP should have been offered clinically appropriate choices for their elective care, initially from a list of four or more providers commissioned by their PCT. Since April 2008, patients can choose any clinically appropriate hospital provider that meets NHS standards and costs in England. As set out in the NHS Constitution, from April 2009 patients have a legal right to choose the organisation that provides their NHS care when referred for their first outpatient appointment.

The Department of Health commissioned a series of national patient choice surveys to assess the implementation of choice at PCT level. Previous reports gave the results of earlier surveys, for referrals made from May/June 2006 to September 2008, using an extended questionnaire from November 2007. This report gives summary results of around 76,000 responses to the sixteenth such survey, for referrals made in December 2008.

Key findings

- The percentage of patients recalling being offered a choice of hospital for their first outpatient appointment was 46% in December 2008, the same as in September and up from 30% in the first survey (May/June 2006).
- 50% of patients were aware before they visited their GP that they had a choice of hospitals for their first appointment, up from 48% in September and 29% in the May/June 2006 survey.
- 61% of patients who were aware of choice recalled being offered choice, whereas 32% of those not aware of choice recalled being offered it, similar to the September survey (61% and 33% respectively).

1 Eligible patients are those for whom a choice of providers should be offered for their elective care, although in some cases the number of appropriate choices might be reduced for clinical reasons. Other patients might receive choice but they are exempted from requiring at least four commissioned options. This includes patients for whom the speed of access to diagnosis and treatment is particularly important: emergency attendances, Rapid Access Chest Pain Clinics or patients attending cancer services under the 2 week maximum waiting time and those where other aspects of choice may be more important: maternity services and mental health.

Further information is given in the Policy Framework for Choice and Booking at the point of Referral “Choose & Book” – Patient’s Choice of Hospital and Booked Appointment, DH August 2004, Gateway ref: 3467.

2 Report of the National Patient Choice Survey – May/June 2006 England, DH, November 2006 3 Report on the National Patient Choice Survey – September 2008 England, DH, February 2009.

See the DH website for the full set of published reports at: www.dh.gov.uk/en/Publicationsandstatistics/Statistics/StatisticalWorkAreas/Statisticalhealthcare/DH_086298 • 68% of patients were able to go to the hospital they wanted, with a further 23% having no preference and 7% unable to go where they wanted, compared with 67%, 23% and 8% respectively in September.

• 90% of patients offered choice were able to go to the hospital they wanted, with a further 4% having no preference. This compares with 48% of patients not offered choice able to go where they wanted and 40% having no preference.

• 80% of patients were satisfied with how long they had to wait from the time their GP referred them to when they saw the hospital specialist.

• Hospital cleanliness and low infection rates were selected most often (by 74% of patients) as an important factor when choosing a hospital.

Choice of hospital The percentage of patients who recalled being offered a choice of hospital for their first outpatient appointment was 46% in December. This compares with between 43% and 47% doing so in surveys from May 2007 to September 2008 and 30% in the first (May/June 2006) survey. The percentage of patients aware of choice has kept rising, see Figure 1 and Annex Table A.2. In addition, 41% of patients in December said they discussed which hospital they might go to with their GP.

Figure 1. Percentage of patients aware of and offered choice and able to go to the hospital they wanted, surveys to date

Awareness of choice The percentage of patients who said that they knew before visiting their GP that there is now choice of hospital for a first hospital appointment was 50% in December 2008, up from 48% in September and 29% in the first (May/June 2006), see Figure 1 and Annex Table A.2.

The 50% of patients who were aware of choice were more likely to say that they were offered a choice of hospital than those who were unaware of choice. 61% of patients who knew about choice recalled being offered it, whereas only 32% of those not knowing about choice recalled being offered it (Annex Table A.1). This difference is similar to previous surveys (eg 61% and 33% respectively in September).

**Going to the hospital of choice**

68% of patients were able to go to the hospital they wanted, with a further 23% having no preference and 7% unable to go where they wanted. This is similar to the September survey, when 67% of patients went to the hospital they wanted, 23% had no preference and 8% were unable to go where they wanted. For patients offered choice, 90% were able to go where they wanted whilst 5% were not and 4% had no preference. This was different from patients not offered choice, 48% of whom went where they wanted but 40% did not have a preference, see Figure 2 and Annex Table A.3. This may imply that the process of being offered and discussing choice helps patients to decide a preferred hospital.

**Figure 2. Percentage of patients who were able to go to the hospital they wanted, by whether they were offered choice**

Sources of information on choice

Almost half the patients (48%) who were offered choice said they used the GP as a source of information to choose their hospital, with a third (33%) saying they used their own experience or that of friends and family. A booklet about choice was used by 8% patients, whilst 5% used the NHS Choices website, see Figure 3 and Annex Table A.4. Factors influencing choice Hospital cleanliness and low infection rates were given most often (by 74% of patients) as an important factor when choosing a hospital. Of all the factors listed for patients to select (as many as apply), six were given by more than half the patients, see Figure 4 and Annex Table A.5. The factors listed were all those that had been commonly identified in previous surveys. Patients selected 5.4 factors on average. The same six factors were selected most often in December as in the previous surveys. The other five are quality of care (given by 64% of patients), waiting times (63%), the friendliness of staff (57%), the reputation of the hospital (55%) and location or transport considerations (54%).

Booking the first appointment 37% of patients booked their first hospital appointment when the hospital contacted them following a letter from the GP, the same as in the September survey. Of the others, 29% patients telephoned an appointments line, 20% were booked on screen (by the GP or other practice staff) and 4% used the internet, again similar to September. Nearly half the patients (49%) who did not recall being offered choice booked their appointment when the hospital contacted them, whilst only a quarter (25%) of patients who were offered choice booked this way, see Annex Table A.3.

Waiting for the first appointment 80% of patients were satisfied with how long they had to wait from the time their GP referred them to when they saw the hospital specialist, compared with 77% in September. The level of satisfaction was higher amongst those who were offered choice (85%, with 12% dissatisfied) than amongst those who weren't (77%, with 17% dissatisfied), see Annex Table A.3, which may indicate a benefit of offering choice.

Results by type of provider The proportion of patients offered choice whose first outpatient appointment was in an Independent Sector (IS) provider was higher than for patients going to NHS organisations: 66% compared with 46%, see Figure 5 and Annex Table A.6. This compares with 62% for those going to IS and 46% for NHS providers in the September survey. However, only 792 (1%) patients taking part in the survey went to IS providers. As before, the difference between the proportions of patients from IS and NHS providers who were aware of choice before visiting their GP was small.

Figure 5. Percentage of patients aware of choice and offered choice, by provider type

Variation by SHA The proportion of patients who recalled being offered a choice of hospital for their first outpatient appointment, 46% nationally, varied by SHA as shown in Figure 6 and Annex Table A.9. Most SHAs showed an increase in the percentage of patients offered choice in December compared with the May 2008 survey, but did not show an increase compared with the September 2008 survey. The proportion of patients who were aware that they had a choice of hospital for their first outpatient appointment, 50% nationally, varied by SHA as shown in Figure 7 and Annex Table A.10. Most SHAs continue to show a sustained increase in patient awareness of choice over the surveys to date.

Note: SHA results are not weighted to adjust for age and sex bias in the responding sample, see Annex B, whereas national estimate are weighted. Variation by PCT

In 16 out of 152 PCTs (11%), over 60% of patients were offered choice, see Figure 8 and Annex Table A.8. This compares with 13 PCTs in the September survey with over 60% of patients offered choice. The proportion of patients aware of choice was under 40% in 7 (5%) PCTs, down from 10 (7%) in the September survey and 33 (22%) in the March 2008 survey.

Figure 8. Number of PCTs by the proportions of patients offered choice and aware of choice

The percentage of patients able to go to the hospital they wanted, 68% nationally, varied by PCT as shown in Figure 9 and Annex Table A.7. Most of the remaining patients had no preference (23% nationally), although more than 10% patients said they were not able to go where they wanted in 33 (22%) PCTs. PCTs where fewer patients were able to go where they wanted tended to have lower levels of choice being offered.

Figure 9. Percentage of patients able to go where they wanted and offered choice, by ranked PCT The geographic variation in the percentage of patients who said they were offered a choice of hospital in December and in September is illustrated in the PCT maps in Figure 10, see also Annex Table A.7. However, some PCT figures are based on few responses, with the possibility of response bias, so results for individual PCTs should be treated with caution.

Figure 10. PCT Maps of percentage of patients offered choice Annex A: Tables of results of the National Patient Choice Survey - December 2008 England

Table A.1 Patients aware of choice, discussing choice and offered choice, December 2008.

| Q1 Before you visited your GP, did you know that you now have a choice of hospitals that you can go to for your first hospital appointment? | Total | Yes | No | |---|---|---|---| | Number | Percent | Number | Percent | Number | Percent | | 75,878 | 100% | 37,758 | 50% | 37,625 | 50% |

Q2 Did you discuss which hospital you might go to with your GP?

| | Yes | No | Don’t know | Not stated | |---|---|---|---|---| | Number | Percent | Number | Percent | Number | Percent | | 30,763 | 41% | 20,674 | 55% | 10,034 | 27% | | 42,597 | 56% | 16,300 | 43% | 26,195 | 70% | | 1,864 | 2% | 605 | 2% | 1,249 | 3% | | 654 | 1% | 179 | 0% | 147 | 0% | | Total | 75,878 | 100% | 37,758 | 100% | 37,625 | 100% |

Q3 Were you offered a choice of hospital for your first hospital appointment?

| | Yes | No | Don’t know | Not stated | |---|---|---|---|---| | Number | Percent | Number | Percent | Number | Percent | | 35,209 | 46% | 23,090 | 61% | 12,052 | 32% | | 37,416 | 49% | 13,248 | 35% | 24,065 | 64% | | 2,398 | 3% | 1,092 | 3% | 1,298 | 3% | | 855 | 1% | 328 | 1% | 210 | 1% | | Total | 75,878 | 100% | 37,758 | 100% | 37,625 | 100% |

1. Apart from Q1, percentages are calculated as a proportion of the total within each column.
2. Total columns include responding patients who did not state whether they knew they had a choice of hospitals before visiting their GP. This accounts for 495 (1%) responses. Table A.2 Patients aware of choice, offered choice and able to go to the hospital they wanted, surveys to date

| Survey | Total | Aware of choice | Offered choice | Able to go where wanted | |-----------------|-------|-----------------|----------------|-------------------------| | | | %Yes | %No | %Yes | %No | %Yes | %No | %No preference | | May/June 2006 | 78,773| 29% | 69% | 30% | 64% | | | | | July 2006 | 70,084| 32% | 67% | 35% | 59% | | | | | September 2006 | 70,580| 32% | 67% | 38% | 57% | | | | | November 2006 | 56,928| 35% | 64% | 41% | 53% | | | | | January 2007 | 73,000| 36% | 63% | 45% | 50% | | | | | March 2007 | 75,290| 37% | 62% | 48% | 52% | | | | | May 2007 | 75,191| 38% | 61% | 44% | 50% | | | | | July 2007 | 62,264| 38% | 61% | 43% | 50% | | | | | September 2007 | 92,545| 39% | 60% | 45% | 49% | | | | | November 2007 | 77,804| 41% | 58% | 44% | 52% | 65% | 7% | 25% | | January 2008 | 72,153| 43% | 57% | 46% | 50% | 67% | 7% | 23% | | March 2008 | 109,331| 43% | 56% | 47% | 48% | 67% | 7% | 23% | | May 2008 | 89,903| 45% | 54% | 45% | 50% | 66% | 8% | 24% | | July 2008 | 93,528| 47% | 53% | 46% | 49% | 66% | 8% | 23% | | September 2008 | 93,003| 48% | 51% | 46% | 50% | 67% | 8% | 23% | | December 2008 | 75,878| 50% | 50% | 46% | 49% | 68% | 7% | 23% |

1. Response to Q1 ‘Before you visited your GP, did you know that you now have a choice of hospitals that you can go to for your first hospital appointment?’
2. Response to Q3 ‘Were you offered a choice of hospital for your first hospital appointment?’
3. Response to Q5 (introduced November 2007) ‘Were you able to go to the hospital that you wanted to go to?’
4. Total valid responses, weighted by age and sex (see Annex B); includes patients who replied ‘don’t know’ or did not respond to the question. Table A.3 Patient going where wanted, booking and satisfaction with wait, December 2008.

| Q3 Were you offered a choice of hospital for your first hospital appointment? | Total | Yes | No | |---|---|---|---| | Number | Percent | Number | Percent | Number | Percent | | 75,878 | 100% | 35,209 | 46% | 37,416 | 49% |

Q5 Were you able to go to the hospital that you wanted to go to?

| | Yes | No | I didn't have a preference | Not stated | |---|---|---|---|---| | Number | Percent | Number | Percent | Number | Percent | | 51,478 | 68% | 31,664 | 90% | 17,933 | 48% | | 5,497 | 7% | 1,851 | 5% | 3,497 | 9% | | 17,140 | 23% | 1,372 | 4% | 14,951 | 40% | | 1,763 | 2% | 323 | 1% | 1,034 | 3% | | Total | 75,878 | 100% | 35,209 | 100% | 37,416 | 100% |

Q6 How did you book your first hospital appointment?

| | GP wrote and hospital contacted me | Telephoned a call centre | On screen (with GP or practice staff) | Via internet | All other responses | Total | |---|---|---|---|---|---|---| | Number | Percent | Number | Percent | Number | Percent | Number | Percent | | 28,145 | 37% | 22,374 | 29% | 15,206 | 20% | 3,404 | 4% | 6,748 | 9% | 75,878 | 100% | | 8,726 | 25% | 15,074 | 43% | 7,310 | 21% | 2,528 | 7% | 1,572 | 4% | 35,209 | 100% | | 18,245 | 49% | 6,636 | 18% | 7,290 | 19% | 817 | 2% | 4,428 | 12% | 37,416 | 100% |

Q7 How satisfied or dissatisfied were you with how long you had to wait from the time your GP referred you to a hospital to when you actually saw the hospital?

| | Very satisfied | Fairly satisfied | Not very satisfied | Not at all satisfied | No appointment date yet | Don't know / not stated | Total | |---|---|---|---|---|---|---|---| | Number | Percent | Number | Percent | Number | Percent | Number | Percent | | 34,687 | 46% | 26,193 | 35% | 6,959 | 9% | 4,103 | 5% | 2,377 | 3% | 1,560 | 2% | 75,878 | 100% | | 17,724 | 50% | 12,055 | 34% | 1,419 | 4% | 1,419 | 4% | 758 | 2% | 368 | 1% | 35,209 | 100% | | 15,797 | 42% | 13,071 | 35% | 2,540 | 7% | 1,464 | 4% | 753 | 2% | 753 | 2% | 37,416 | 100% |

1. Apart from Q3, percentages are calculated as a proportion of the total within each column.
2. Total columns include responding patients who did not know or did not state whether they were offered a choice of hospital. This accounts for 3,253 (4%) responses.

Table A.4 Sources of information used for choosing a hospital, December 2008.

| Sources listed | No. patients | Percent of responses | |---|---|---| | My GP | 16,956 | 48% | | Friends/family members/own experience | 11,727 | 33% | | A booklet or leaflet about my choices | 2,841 | 8% | | NHS Choices website | 1,842 | 5% | | Staff at Clinical Assessment or Referral Centre | 1,485 | 4% | | Someone at GP surgery | 1,334 | 4% | | Other internet site | 350 | 1% | | Local patient organisation | 334 | 1% | | Other | 4,345 | 12% | | None of these | 2,920 | 8% | | Don't know | 276 | 1% |

1. Patients who said they had been offered choice were invited to select, from a list of sources, those they used when choosing the hospital. On average, patients selected 1.2 sources. Table A.5 Factors when choosing a hospital, December 2008.

| Most important factors listed | No. patients | Percent of responses | |------------------------------|--------------|---------------------| | Cleanliness / Low levels of infection | 55,961 | 74% | | Quality of care | 48,453 | 64% | | Length of wait to appointment | 47,596 | 63% | | Friendliness of staff | 42,952 | 57% | | Reputation of hospital | 41,394 | 55% | | Location / Transport / Easy to get to | 41,051 | 54% | | Car parking | 35,637 | 47% | | Reputation of consultant | 33,936 | 45% | | Good personal experience | 31,125 | 41% | | Convenience of appointment time | 28,808 | 38% | | Other | 884 | 1% | | None of these | 187 | 0% | | Don't know | 392 | 1% |

1. Patients were invited to select, from a list of factors, those they considered most important to them when choosing a hospital (whether they were offered a choice on this occasion or not). On average, patients selected 5.4 factors.

Table A.6 Patient responses by type of provider, December 2008

| Type of provider of outpatient service | Total | Independent Sector | NHS | |---------------------------------------|-------|--------------------|-----| | | Number | Percent | Number | Percent | Number | Percent | | Q1 Before you visited your GP, did you know that you now have a choice of hospitals that you can go to for your first hospital appointment? | | | | | | | | Yes | 37,758 | 50% | 389 | 54% | 37,369 | 50% | | No | 37,625 | 50% | 333 | 46% | 37,292 | 50% | | Not stated | 495 | 1% | 2 | 0% | 493 | 1% | | Total | 75,878 | 100% | 724 | 100% | 75,154 | 100% | | Q3 Were you offered a choice of hospital for your first hospital appointment? | | | | | | | | Yes | 35,209 | 46% | 476 | 66% | 34,733 | 46% | | No | 37,416 | 49% | 225 | 31% | 37,191 | 49% | | Don't know | 2,398 | 3% | 18 | 3% | 2,380 | 3% | | Not stated | 855 | 1% | 4 | 1% | 850 | 1% | | Total | 75,878 | 100% | 724 | 100% | 75,154 | 100% | | Q5 Were you able to go to the hospital that you wanted to go to? | | | | | | | | Yes | 51,478 | 68% | 562 | 78% | 50,917 | 68% | | No | 5,497 | 7% | 28 | 4% | 5,469 | 7% | | I didn't have a preference | 17,140 | 23% | 125 | 17% | 17,015 | 23% | | Not stated | 1,763 | 2% | 9 | 1% | 1,754 | 2% | | Total | 75,878 | 100% | 724 | 100% | 75,154 | 100% | | Q7 How satisfied or dissatisfied were you with how long you had to wait from the time your GP referred you to a hospital to when you actually saw the hospital? | | | | | | | | Very satisfied | 34,687 | 46% | 566 | 78% | 34,121 | 45% | | Fairly satisfied | 26,193 | 35% | 118 | 16% | 26,075 | 35% | | Not very satisfied | 6,959 | 9% | 18 | 3% | 6,940 | 9% | | Not at all satisfied | 4,103 | 5% | 14 | 2% | 4,089 | 5% | | No appointment date yet | 2,377 | 3% | 4 | 1% | 2,373 | 3% | | Don't know / not stated | 1,559 | 2% | 4 | 1% | 1,556 | 2% | | Total | 75,878 | 100% | 724 | 100% | 75,154 | 100% |

1. Responses may not sum to total due to rounding following age and sex weighting of the survey results.
2. Some Independent Sector providers have taken part in the survey, issuing survey forms to their patients, since the November 2006 survey, see Annex B.

### Table A.7 Patients aware of choice, offered choice and going to the hospital they wanted by PCT, December 2008

| PCT | SHA | Total | Aware of choice | Offered choice | Able to go where wanted to go | |------------------------------------------|-----|-------|-----------------|----------------|-------------------------------| | | | | %Yes | %No | %Yes | %No | %Yes | %No | %No preference | | **England** | | | | | | | | | | | Ashton, Leigh and Wigan | NW | 354 | 57% | 43% | 59% | 41% | 75% | 23% | | | Barking and Dagenham | Lon | 203 | 48% | 52% | 54% | 40% | 60% | 20% | | | Barnet | Lon | 420 | 53% | 45% | 51% | 41% | 68% | 16% | | | Barnsley | YH | 159 | 63% | 37% | 60% | 37% | 74% | 17% | | | Bassetlaw | EM | 92 | 65% | 35% | 60% | 38% | 80% | 13% | | | Bath and North East Somerset | SW | 407 | 57% | 43% | 49% | 48% | 75% | 19% | | | Bedfordshire | EoE | 437 | 50% | 49% | 37% | 58% | 67% | 25% | | | Berkshire East Teaching | SC | 176 | 45% | 55% | 44% | 50% | 61% | 22% | | | Berkshire West | SC | 134 | 58% | 41% | 68% | 28% | 84% | 10% | | | Bexley Care Trust | Lon | 256 | 55% | 45% | 49% | 46% | 68% | 20% | | | Birmingham East and North | WM | 84 | 56% | 43% | 56% | 42% | 69% | 20% | | | Blackburn with Darwen | | | | | | | | | | | Teaching | NW | 143 | 62% | 38% | 57% | 40% | 76% | 10% | | | Blackpool | NW | 307 | 56% | 44% | 48% | 48% | 73% | 20% | | | Bolton | NW | 375 | 59% | 40% | 55% | 42% | 78% | 17% | | | Bournemouth and Poole | SW | 388 | 54% | 45% | 57% | 39% | 84% | 10% | | | Bradford and Airedale Teaching | YH | 628 | 48% | 52% | 36% | 59% | 56% | 31% | | | Brent Teaching | Lon | 239 | 42% | 58% | 44% | 47% | 64% | 25% | | | Brighton and Hove City Teaching | SEC | 246 | 40% | 59% | 26% | 68% | 53% | 37% | | | Bristol Teaching | SW | 403 | 43% | 57% | 49% | 46% | 72% | 18% | | | Bromley | Lon | 73 | 48% | 52% | 48% | 47% | 64% | 22% | | | Buckinghamshire | SC | 873 | 51% | 48% | 48% | 47% | 71% | 22% | | | Bury | NW | 120 | 56% | 43% | 58% | 42% | 77% | 17% | | | Calderdale | YH | 427 | 54% | 45% | 48% | 48% | 79% | 13% | | | Cambridgeshire | EoE | 834 | 48% | 51% | 36% | 59% | 75% | 17% | | | Camden | Lon | 229 | 55% | 44% | 55% | 39% | 79% | 17% | | | Central & Eastern Cheshire | NW | 1,107 | 55% | 44% | 45% | 51% | 71% | 21% | | | Central Lancashire | NW | 216 | 57% | 42% | 56% | 40% | 70% | 16% | | | City and Hackney Teaching | Lon | 235 | 35% | 64% | 37% | 55% | 57% | 32% | | | Cornwall and Isles of Scilly | SW | 702 | 47% | 51% | 46% | 49% | 55% | 24% | | | County Durham | NE | 986 | 67% | 32% | 67% | 31% | 77% | 14% | | | Coventry Teaching | WM | 645 | 60% | 39% | 53% | 42% | 78% | 17% | | | Croydon | Lon | 88 | 56% | 43% | 50% | 48% | 69% | 22% | | | Cumbria | NW | 1,419 | 61% | 38% | 51% | 44% | 72% | 17% | | | Darlington | NE | 223 | 59% | 40% | 44% | 52% | 76% | 16% | | | Derby City | EM | 576 | 49% | 51% | 41% | 54% | 66% | 25% | | | Derbyshire County | EM | 1,208 | 63% | 36% | 58% | 39% | 79% | 15% | | | Devon | SW | 1,590 | 54% | 45% | 45% | 51% | 75% | 17% | | | Doncaster | YH | 317 | 63% | 36% | 46% | 50% | 75% | 17% | | | Dorset | SW | 825 | 63% | 36% | 61% | 34% | 78% | 14% | | | Dudley | WM | 255 | 54% | 45% | 29% | 66% | 56% | 34% | | | Ealing | Lon | 382 | 56% | 44% | 42% | 52% | 64% | 24% | | | East and North Hertfordshire | EoE | 320 | 58% | 41% | 49% | 47% | 66% | 21% | | | East Lancashire | NW | 620 | 61% | 38% | 65% | 32% | 72% | 15% | | | East Riding of Yorkshire | YH | 708 | 45% | 54% | 36% | 60% | 57% | 30% | | | East Sussex Downs and Weald | SEC | 709 | 50% | 50% | 39% | 57% | 70% | 22% | | | Eastern and Coastal Kent | | | | | | | | | | | Teaching | SEC | 1,115 | 49% | 50% | 49% | 46% | 65% | 22% | | | Enfield | Lon | 465 | 55% | 45% | 54% | 41% | 70% | 18% | | | Gateshead | NE | 542 | 63% | 36% | 57% | 41% | 72% | 19% | | | Gloucestershire | SW | 954 | 48% | 51% | 53% | 44% | 72% | 18% | | | Great Yarmouth and Waveney | EoE | 69 | 67% | 33% | 68% | 32% | 78% | 12% | | | Greenwich Teaching | Lon | 349 | 52% | 48% | 52% | 44% | 69% | 22% | | | PCT | SHA | Total | Aware of choice | Offered choice | Able to go where wanted to go | |------------------------------------------|-----|-------|-----------------|----------------|-------------------------------| | | | | %Yes %No | %Yes %No | %Yes %No %No preference | | Halton and St Helens | NW | 723 | 55% 45% | 53% 44% | 70% 9% 20% | | Hammersmith and Fulham | Lon | 245 | 49% 51% | 41% 50% | 69% 6% 22% | | Hampshire | SC | 2,021 | 51% 49% | 47% 50% | 67% 8% 22% | | Haringey Teaching | Lon | 198 | 41% 59% | 43% 52% | 63% 8% 28% | | Harrow | Lon | 183 | 47% 52% | 56% 37% | 74% 7% 17% | | Hartlepool | NE | 56 | 61% 38% | 54% 43% | 66% 13% 20% | | Hastings and Rother | SEC | 489 | 47% 52% | 31% 65% | 62% 9% 25% | | Havering | Lon | 239 | 48% 52% | 53% 43% | 72% 8% 16% | | Heart of Birmingham Teaching | WM | 110 | 45% 55% | 33% 62% | 62% 8% 25% | | Herefordshire | WM | 421 | 46% 53% | 27% 68% | 68% 3% 26% | | Hillingdon | Lon | 557 | 40% 60% | 29% 66% | 57% 9% 30% | | Hounslow | Lon | 181 | 44% 56% | 40% 56% | 66% 4% 25% | | Hull Teaching | YH | 487 | 46% 53% | 36% 60% | 55% 6% 37% | | Isle of Wight Healthcare | SC | 366 | 40% 60% | 19% 76% | 65% 4% 27% | | Islington | Lon | 88 | 55% 45% | 51% 40% | 78% 2% 17% | | Kensington and Chelsea | Lon | 114 | 47% 53% | 50% 45% | 59% 16% 23% | | Kingston | Lon | 58 | 43% 57% | 31% 67% | 47% 14% 38% | | Kirklees | YH | 732 | 49% 49% | 48% 48% | 72% 7% 19% | | Knowsley | NW | 184 | 47% 52% | 42% 54% | 60% 10% 23% | | Lambeth | Lon | 174 | 47% 52% | 59% 42% | 67% 11% 20% | | Leeds | YH | 1,439 | 48% 52% | 37% 59% | 54% 12% 31% | | Leicester City Teaching | EM | 566 | 40% 59% | 31% 63% | 45% 16% 36% | | Leicestershire County and Rutland | EM | 974 | 48% 52% | 43% 53% | 57% 11% 28% | | Lewisham | Lon | 289 | 46% 53% | 39% 55% | 64% 6% 26% | | Lincolnshire Teaching | EM | 2,066 | 60% 40% | 50% 46% | 68% 9% 21% | | Liverpool | NW | 422 | 54% 45% | 54% 41% | 74% 4% 19% | | Luton Teaching | EoE | 15 | 40% 53% | 53% 40% | 73% 0% 20% | | Manchester | NW | 728 | 48% 51% | 41% 54% | 69% 7% 21% | | Medway Teaching | SEC | 70 | 50% 49% | 63% 33% | 70% 10% 20% | | Mid Essex | EoE | 677 | 43% 57% | 31% 65% | 56% 5% 35% | | Middlesbrough | NE | 232 | 72% 28% | 66% 32% | 88% 4% 7% | | Milton Keynes | SC | 647 | 39% 60% | 28% 67% | 60% 4% 32% | | Newcastle | NE | 384 | 55% 45% | 29% 67% | 57% 5% 37% | | Newham | Lon | 274 | 42% 58% | 37% 54% | 59% 10% 28% | | Norfolk | EoE | 1,190 | 55% 45% | 51% 46% | 79% 4% 15% | | North East Essex | EoE | 887 | 46% 53% | 40% 55% | 63% 7% 25% | | North East Lincolnshire | YH | 290 | 60% 40% | 36% 62% | 64% 8% 27% | | North Lancashire | NW | 793 | 61% 38% | 56% 40% | 76% 5% 16% | | North Lincolnshire | YH | 332 | 62% 37% | 57% 39% | 72% 6% 17% | | North Somerset | SW | 558 | 47% 50% | 41% 54% | 70% 5% 22% | | North Staffordshire | WM | 503 | 57% 42% | 56% 41% | 76% 6% 17% | | North Tees | NE | 144 | 56% 43% | 51% 44% | 65% 11% 24% | | North Tyneside | NE | 486 | 60% 39% | 40% 57% | 66% 5% 28% | | North Yorkshire and York | YH | 1,577 | 52% 47% | 41% 55% | 74% 5% 19% | | Northamptonshire Teaching | EM | 1,295 | 60% 40% | 54% 41% | 74% 7% 18% | | Northumberland Care Trust | NE | 624 | 58% 41% | 43% 53% | 67% 5% 25% | | Nottingham City | EM | 384 | 54% 45% | 47% 49% | 68% 8% 21% | | Nottinghamshire County Teaching | EM | 1,328 | 60% 40% | 59% 38% | 79% 5% 14% | | Oldham | NW | 51 | 59% 41% | 75% 25% | 78% 8% 14% | | Oxfordshire | SC | 805 | 57% 43% | 49% 47% | 77% 3% 18% | | Peterborough | EoE | 297 | 41% 59% | 35% 62% | 61% 8% 30% | | Plymouth Teaching | SW | 272 | 55% 45% | 51% 44% | 72% 4% 21% | | Portsmouth City Teaching | SC | 392 | 53% 47% | 45% 49% | 64% 8% 26% | | Redbridge | Lon | 419 | 53% 46% | 43% 53% | 63% 11% 25% | | Redcar and Cleveland | NE | 267 | 66% 33% | 49% 47% | 74% 3% 19% | | Richmond and Twickenham | Lon | 42 | 31% 69% | 52% 43% | 52% 14% 31% | | Rochdale, Heywood and Middleton | NW | 47 | 47% 53% | 62% 32% | 64% 13% 23% | | PCT | SHA | Total | Aware of choice | Offered choice | Able to go where wanted to go | |-----|-----|-------|-----------------|----------------|-------------------------------| | | | | %Yes | %No | %Yes | %No | %Yes | %No | %No preference | | Rotherham | YH | 74 | 70% | 27% | 61% | 34% | 80% | 4% | 14% | | Salford Teaching | NW | 344 | 62% | 38% | 50% | 48% | 80% | 4% | 15% | | Sandwell | WM | 88 | 50% | 49% | 55% | 41% | 75% | 9% | 13% | | Sefton | NW | 356 | 46% | 53% | 39% | 58% | 62% | 4% | 32% | | Sheffield | YH | 1,156 | 51% | 48% | 39% | 56% | 65% | 7% | 25% | | Shropshire County | WM | 84 | 56% | 43% | 58% | 38% | 73% | 8% | 15% | | Solihull | WM | 33 | 64% | 33% | 73% | 27% | 76% | 12% | 12% | | Somerset | SW | 547 | 62% | 37% | 62% | 35% | 73% | 8% | 17% | | South Birmingham | WM | 331 | 39% | 60% | 30% | 64% | 61% | 2% | 34% | | South East Essex | EoE | 93 | 48% | 51% | 58% | 39% | 73% | 4% | 16% | | South Gloucestershire | SW | 364 | 46% | 53% | 43% | 53% | 67% | 10% | 21% | | South Staffordshire | WM | 715 | 60% | 39% | 48% | 47% | 70% | 6% | 21% | | South Tyneside | NE | 273 | 72% | 28% | 44% | 52% | 72% | 5% | 21% | | South West Essex Teaching | EoE | 573 | 50% | 49% | 53% | 45% | 70% | 8% | 20% | | Southampton City | SC | 342 | 32% | 67% | 20% | 73% | 48% | 9% | 39% | | Southwark | Lon | 92 | 40% | 60% | 46% | 48% | 68% | 7% | 21% | | Stockport | NW | 444 | 54% | 45% | 53% | 42% | 77% | 4% | 17% | | Stoke on Trent Teaching | WM | 248 | 60% | 39% | 60% | 36% | 75% | 5% | 18% | | Suffolk | EoE | 612 | 48% | 50% | 33% | 62% | 60% | 5% | 25% | | Sunderland Teaching | NE | 741 | 65% | 34% | 45% | 50% | 74% | 4% | 19% | | Surrey | SEC | 1,855 | 50% | 49% | 47% | 49% | 70% | 7% | 20% | | Sutton and Merton | Lon | 502 | 46% | 54% | 42% | 52% | 64% | 11% | 23% | | Swindon | SW | 289 | 48% | 51% | 33% | 64% | 72% | 1% | 24% | | Tameside and Glossop | NW | 459 | 63% | 37% | 62% | 36% | 79% | 4% | 17% | | Telford and Wrekin | WM | 6 | 50% | 50% | 83% | 17% | 67% | 33% | 0% | | Torbay Care Trust | SW | 410 | 54% | 45% | 42% | 55% | 77% | 5% | 16% | | Tower Hamlets | Lon | 41 | 54% | 46% | 56% | 37% | 66% | 12% | 17% | | Trafford | NW | 224 | 45% | 54% | 43% | 51% | 68% | 11% | 19% | | Wakefield | YH | 757 | 52% | 48% | 50% | 47% | 65% | 9% | 23% | | Walsall Teaching | WM | 268 | 59% | 40% | 40% | 52% | 70% | 5% | 22% | | Waltham Forest | Lon | 428 | 47% | 53% | 44% | 50% | 65% | 10% | 23% | | Wandsworth | Lon | 46 | 52% | 48% | 50% | 46% | 70% | 15% | 11% | | Warrington | NW | 433 | 54% | 46% | 39% | 57% | 71% | 3% | 24% | | Warwickshire | WM | 490 | 57% | 43% | 63% | 35% | 77% | 7% | 15% | | West Cheshire | NW | 386 | 52% | 47% | 44% | 51% | 76% | 5% | 17% | | West Essex | EoE | 283 | 57% | 42% | 46% | 52% | 72% | 4% | 21% | | West Hertfordshire | EoE | 965 | 41% | 58% | 39% | 57% | 61% | 9% | 26% | | West Kent | SEC | 509 | 42% | 56% | 39% | 55% | 67% | 6% | 24% | | West Sussex Teaching | SEC | 957 | 51% | 48% | 50% | 45% | 74% | 8% | 16% | | Westminster | Lon | 115 | 37% | 63% | 33% | 57% | 65% | 10% | 23% | | Wiltshire | SW | 688 | 56% | 43% | 50% | 46% | 76% | 4% | 17% | | Wirral | NW | 192 | 57% | 42% | 52% | 44% | 69% | 6% | 22% | | Wolverhampton City | WM | 436 | 45% | 54% | 32% | 65% | 70% | 3% | 25% | | Worcestershire | WM | 123 | 55% | 43% | 50% | 44% | 63% | 11% | 24% |

1. Response to Q1 'Before you visited your GP, did you know that you now have a choice of hospitals that you can go to for your first hospital appointment?'
2. Response to Q3 'Were you offered a choice of hospital for your first hospital appointment?'
3. Response to Q5 'Were you able to go to the hospital that you wanted to go to?'
4. Responsible Care Trusts and Primary Care Trusts based on reconfigured (post 1 October 2006) organisations, see Annex B. PCT results are not weighted for any age or sex bias among respondents.
5. SHA is based on a mapping of responsible PCTs to Strategic Health Authorities: NE (North East), NW (North West), YH (Yorkshire & the Humber), EM (East Midlands), WM (West Midlands), EoE (East of England), Lon (London), SEC (South East Coast), SC (South Central) and SW (South West).
6. Total valid responses, including patients who replied 'don’t know' or did not respond to the question. The national total is weighted and includes 3,482 (5%) weighted cases not listed by responsible PCT because the PCT was not clear. Results for PCTs with fewer than 50 responses should be treated with some caution (see Annex B Issues for PCT results).

### Table A.8 Number and percentage of PCTs by percentage of patients offered choice, surveys to date.

| May/June 2006 | November 2007 | January 2008 | March 2008 | May 2008 | July 2008 | September 2008 | December 2008 | |---------------|---------------|--------------|------------|----------|-----------|----------------|---------------| | No. of PCTs | % of PCTs | No. of PCTs | % of PCTs | No. of PCTs | % of PCTs | No. of PCTs | % of PCTs | | 60% and over | 14 5% | 10 7% | 18 12% | 11 7% | 7 5% | 14 9% | 13 9% | 16 11% | | 50% to \<60% | 17 6% | 39 26% | 39 26% | 49 32% | 50 33% | 50 33% | 52 34% | 48 32% | | 40% to \<50% | 34 11% | 53 35% | 60 39% | 61 40% | 58 38% | 52 34% | 51 34% | 53 35% | | 30% to \<40% | 71 23% | 39 26% | 27 18% | 28 18% | 31 20% | 28 18% | 29 19% | 26 17% | | 20% to \<30% | 104 34% | 10 7% | 8 5% | 3 2% | 6 4% | 8 5% | 7 5% | 7 5% | | 10% to < 20% | 59 19% | 1 1% | 0 0% | 0 0% | 0 0% | 0 0% | 0 0% | 2 1% | | \<10% | 4 1% | 0 0% | 0 0% | 0 0% | 0 0% | 0 0% | 0 0% | 0 0% | | Total | 303 100% | 152 100% | 152 100% | 152 100% | 152 100% | 152 100% | 152 100% | 152 100% |

1. For results of the July 2006 to September 2007 surveys, see previous reports.
2. Prior to PCT reconfiguration on 1 October 2006, there were 303 organisations (Care Trusts and Primary Care Trusts), compared with 152 subsequently.
3. Percentage of patients who said Yes to: ‘Were you offered a choice of hospital for your first hospital appointment?’

### Table A.9 Percentage of patients offered choice by SHA, surveys to date

| May/June 2006 | November 2007 | January 2008 | March 2008 | May 2008 | July 2008 | September 2008 | December 2008 | |---------------|---------------|--------------|------------|----------|-----------|----------------|---------------| | Total | %Yes | Total | %Yes | Total | %Yes | Total | %Yes | | England | 78,773 30% | 77,804 44% | 72,153 46% | 109,331 47% | 89,903 45% | 93,528 46% | 93,003 46% | 75,878 46% | | North East | 4,238 28% | 5,141 44% | 4,225 44% | 6,824 51% | 5,587 47% | 3,922 52% | 5,577 50% | 4,958 50% | | North West | 11,252 39% | 11,774 49% | 9,865 52% | 14,117 52% | 12,751 51% | 13,139 52% | 13,084 52% | 10,447 51% | | Yorks & Humber| 9,321 26% | 10,203 39% | 9,235 42% | 12,486 44% | 9,831 41% | 10,699 41% | 12,165 43% | 9,083 42% | | East Midlands | 7,240 38% | 7,518 52% | 7,168 54% | 10,269 56% | 8,514 52% | 9,701 52% | 10,113 52% | 8,489 51% | | West Midlands | 7,355 30% | 5,531 44% | 6,333 46% | 8,605 45% | 8,208 43% | 8,002 43% | 7,119 44% | 4,840 46% | | East of England| 8,580 24% | 7,597 37% | 7,663 39% | 11,442 40% | 8,976 37% | 8,295 39% | 8,764 40% | 7,252 42% | | London | 9,350 30% | 8,071 43% | 7,857 45% | 11,563 45% | 10,433 45% | 10,318 45% | 8,634 43% | 7,224 45% | | South East Coast| 7,490 20% | 4,962 40% | 5,006 43% | 8,642 45% | 7,530 44% | 6,880 43% | 7,797 44% | 5,950 44% | | South Central | 5,204 34% | 5,011 44% | 4,305 45% | 6,486 47% | 6,051 44% | 7,001 46% | 6,150 45% | 5,756 42% | | South West | 8,747 27% | 6,278 46% | 5,629 50% | 10,690 49% | 8,455 48% | 11,177 50% | 8,274 49% | 8,397 49% |

1. For results of the July 2006 to September 2007 surveys, see previous reports.
2. Total valid responses. From November 2006, total includes cases not identifiable by SHA (see Annex B).
3. Percentage of patients who said Yes to: ‘Were you offered a choice of hospital for your first hospital appointment?’
4. SHA results are not weighted for any age or sex bias among respondents. Table A.10 Percentage of patients aware of choice by SHA, surveys to date

| SHA | May/June 2006¹ | November 2007 | January 2008 | March 2008 | May 2008 | July 2008 | September 2008 | December 2008 | |----------------------|----------------|---------------|--------------|------------|----------|-----------|----------------|---------------| | | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | | England | 78,773 29% | 77,804 41% | 72,153 43% | 109,331 43% | 89,903 45% | 93,528 47% | 93,003 48% | 75,878 50% | | North East | 4,238 30% | 5,141 45% | 4,225 46% | 6,824 47% | 5,587 49% | 3,922 55% | 5,577 58% | 4,958 63% | | North West | 11,252 34% | 11,774 46% | 9,865 48% | 14,117 47% | 12,751 50% | 13,139 53% | 13,084 54% | 10,447 56% | | Yorks & Humber | 9,321 30% | 10,203 42% | 9,235 43% | 12,486 45% | 9,831 46% | 10,699 49% | 12,165 51% | 9,083 51% | | East Midlands | 7,240 36% | 7,518 51% | 7,168 51% | 10,269 51% | 8,514 53% | 9,701 53% | 10,113 56% | 8,489 57% | | West Midlands | 7,355 31% | 5,531 45% | 6,333 48% | 8,605 47% | 8,208 48% | 8,002 51% | 7,119 52% | 4,840 54% | | East of England | 8,580 31% | 7,597 42% | 7,663 41% | 11,442 43% | 8,976 43% | 8,295 45% | 8,764 47% | 7,252 48% | | London | 9,350 32% | 8,071 40% | 7,857 42% | 11,563 43% | 10,433 46% | 10,318 46% | 8,634 46% | 7,224 48% | | South East Coast | 7,490 28% | 4,962 38% | 5,005 39% | 8,642 41% | 7,530 43% | 6,880 45% | 7,797 46% | 5,950 48% | | South Central | 5,204 32% | 5,011 43% | 4,305 41% | 6,486 43% | 6,051 46% | 7,001 48% | 6,150 48% | 5,756 49% | | South West | 8,747 31% | 6,278 44% | 5,629 46% | 10,690 47% | 8,455 50% | 11,177 49% | 8,274 51% | 8,397 53% |

1. For results of the July 2006 to September 2007 surveys, see previous reports.
2. Total valid responses. From November 2006, total includes cases not identifiable by SHA (see Annex B).
3. Percentage of patients who said Yes to: ‘Before you visited your GP, did you know that you now have a choice of hospitals that you can go to for your first hospital appointment?’
4. SHA results are not weighted for any age or sex bias among respondents. Annex B: Notes on the survey methodology

Background This is the sixteenth National Patient Choice Survey conducted by Ipsos MORI on behalf of the Department of Health, in a series of surveys planned to monitor patient awareness of choice and recall of having been offered a choice of hospital for their first outpatient appointment. The surveys are designed to provide a national overview of choice and summary results at PCT level. After piloting the methodology with six NHS hospital trusts in February 2006, national surveys have been conducted for referrals in May/June, July, September and November 2006, January, March, May, July, September and November 2007, January, March, May, July, September and now December 2008.

Methodology Patients who had been referred by a GP for a first outpatient appointment in any of 141 major acute NHS trusts or 14 Independent Sector (IS) organisations during the two-week period 15 to 28 December 2008 were invited to take part in the survey. Patients aged under 16 or referred for specialties exempted from choice were omitted from the survey (including urgent referrals, two week wait cancer patients, antenatal patients and those referred to rapid access chest pain clinics or mental health specialties – see footnote on Page 6).

These providers of care together account for over 95% of NHS GP referrals to first outpatient appointments. Although the Independent Sector units receive relatively few referrals, their inclusion in the survey (from November 2006) helps to ensure representation of these patients, who might have a different experience of choice.

The providers were asked to issue the survey questionnaire within a week of the two-week period. Around 218,000 questionnaires were issued. Patients were invited to complete the questionnaire and return it using the pre-paid Ipsos MORI reply envelope. The questionnaires were anonymous except for the information pre-completed regarding the issuing Trust and the responsible PCT of the patient (see below for issues regarding the PCT information). All responses were treated as completely confidential.

The questionnaire for the December 2008 survey was the same as that used for the previous six surveys, following questionnaire redesign in November 2007 (see Annex C for the questionnaire). Response A total 75,916 patients responded to the survey, a response rate of 35%. Of these, 38 responses did not clearly indicate the code of the issuing Trust or IS provider (despite pre-printing of the organisation code) and were omitted as invalid. In addition, 3,335 (4%) responses did not clearly indicate the responsible PCT. Such cases have been included in national analysis since the November 2006 survey, as they have a valid provider code. This resulted in an effective national response rate of 35% (75,878 valid responses). This compares with valid response rates of between 25% and 33% in all surveys to January 2008 except 40% in September 2007, 50% in March 2008 and between 37% and 38% in May to September 2008.

Although the survey results were weighted for age and sex bias among respondents (see below), they may be subject to other response bias for which no adjustment can be made.

Weighting for non-response The age and sex of respondents to the survey was compared with Hospital Episodes Statistics (HES) Outpatients data sourced from the Information Centre for Health and Social Care (IC)(^1). The HES data related to 8.9 million first attendance outpatient appointments in 2006-07 for patients with known sex and age 16 and over where the source of referral was a General Medical Practitioner and the specialty was not one of those excluded from choice (cancer, obstetrics and mental health). There was a lower proportion of younger patients among the survey respondents than in the overall HES distribution, for both males and females, see Figure B.1.

Figure B.1 Percentage of survey respondents by age and sex, compared with the expected distribution

(^1) For details of the IC (HES) Outpatients data, see www.hesonline.org.uk. Although many of the survey results differed only slightly by age and sex, this sample difference is sufficiently marked that the decision was made to weight the national data to adjust for this response bias. No weighting was done by ethnic group since the HES outpatient data did not have an ethnic group recorded for the majority of patients. The national weighting was not applied to PCT or SHA results because the age and sex distribution differs by PCT and the HES outpatient data was not universally complete enough to provide a robust comparison.

Analysis by age, sex and ethnic group Results of the survey by age, sex and ethnic group were last presented in the report for referrals made in March 2008(^1). The report compiled results for the first twelve surveys, since the differences observed by age, sex and ethnic group were generally consistent over all the surveys and otherwise small samples for some groups made comparisons inconclusive. This analysis has been updated to include the subsequent four surveys and is presented in Annex D.

Issues for PCT results Survey forms were marked with the commissioning organisation (Care Trust or Primary Care Trust, PCT) prior to issue. In most cases, issuing organisations identified the responsible PCT on the basis of contemporary PCTs, ie those following reconfiguration from 303 to 152 commissioning organisations on 1 October 2006. In the December survey, 97% of responses were marked with either new PCT codes (67%) or PCTs unaffected by reconfiguration (30%). The remaining 3% of responses had a discontinued PCT code. These were mapped to their new codes (where generally two or more of the 303 PCTs aggregated into one of the 152 reconfigured PCTs) for inclusion in the PCT level results of the survey. SHA results were aggregated from the PCT data (also unweighted).

The number of valid responses received varied by PCT, from fewer than 60 patients in ten PCTs (where there were local problems with the survey process) to more than 1,000 in 14 PCTs, as shown in Annex Table A.7. If responses were unbiased, the average confidence interval(^2) around the percentage of patients offered choice in each PCT would be ± 6%, but in some cases this is as low as ± 2% or, in the worst case, as high as ± 32%. The variable response, possibility of response bias and lack of weighting for age and sex bias at a local level means that PCT results should be treated with some caution.

______________________________________________________________________

(^1) Report on the National Patient Choice Survey – March 2008 England, DH, September 2008

(^2) The 95% confidence interval for a PCT indicates the range in which the percentage of patients responding ‘Yes’ to the question is 95% likely to fall, given sampling error (but assuming no response bias). It is calculated by approximation to a Binomial distribution. Annex C: Survey questionnaire

Q1. Before you visited your GP, did you know that you now have a choice of hospitals that you can go to for your first hospital appointment? PLEASE TICK ONE BOX ONLY Yes ........................................... □ No ........................................... □

Q2. Did you discuss which hospital you might go to with your GP? PLEASE TICK ONE BOX ONLY Yes ........................................... □ No ........................................... □ Don’t know .................................. □

Q3. Were you offered a choice of hospital for your first hospital appointment? PLEASE TICK ONE BOX ONLY Yes ........................................... □ No ........................................... □ Don’t know .................................. □

PLEASE ONLY ANSWER QUESTION 4 IF YOU ANSWERED “YES” TO QUESTION 3 ABOVE

Q4. Which, if any, of the following sources of information did you use to choose the hospital? PLEASE TICK AS MANY BOXES AS APPLY My GP ........................................... □ A booklet or leaflet about my choices □ NHS Choices Website ........................................... □ Other internet site ........................................... □ Friends/family members/own experience ........................................... □ Someone at GP surgery ........................................... □ Local patient organisation ........................................... □ Staff at Clinical Assessment or Referral Centre ........................................... □ Other ........................................... □ None of these ........................................... □ Don’t know ........................................... □

Q5. Were you able to go to the hospital that you wanted to go to? PLEASE TICK ONE BOX ONLY Yes ........................................... □ No ........................................... □ I didn’t have a preference ........................................... □

Q6. How did you book your first hospital appointment? PLEASE TICK ONE BOX ONLY By telephone via the appointments line 0845 608 8888 ........................................... □ On screen (done by GP) ........................................... □ On screen (done by GP practice staff) ........................................... □ On the internet via my Healthspace ........................................... □ On the internet via NHS Choices ........................................... □ The GP wrote to the hospital asking them to contact me ........................................... □ Via a local call centre ........................................... □ Other ........................................... □ Don’t know ........................................... □ I have not booked an appointment yet ........................................... □

Q7. How satisfied or dissatisfied were you with how long you had to wait from the time your GP referred you to a hospital to when you actually saw the hospital specialist? PLEASE TICK ONE BOX ONLY Very satisfied ........................................... □ Fairly satisfied ........................................... □ Not very satisfied ........................................... □ Not at all satisfied ........................................... □ Don’t know ........................................... □ I do not have an appointment date yet ........................................... □ Q8. Which, if any, of the following factors would be most important to you in choosing a hospital? PLEASE TICK AS MANY BOXES AS APPLY

- Car parking
- Cleanliness / Low levels of infection
- Friendliness of staff
- Length of wait to appointment
- Convenience of appointment time
- Good personal experience
- Location / Transport / Easy to get to
- Quality of care
- Reputation of consultant
- Reputation of hospital
- Other
- None of these
- Don’t know

Q9. Are you male or female?

- Male
- Female

Q10. How old are you?

- 16-34
- 35-54
- 55-64
- 65 or over

Q11. To which of these ethnic groups would you say you belong? PLEASE TICK ONE BOX ONLY

- White

  - British
  - Irish
  - Any other white background (Please write in below)

- Mixed

  - White and Black Caribbean
  - White and Black African
  - White and Asian
  - Any other mixed background (Please write in below)

- Asian or Asian British

  - Indian
  - Pakistani
  - Bangladeshi
  - Any other Asian background (Please write in below)

- Black or Black British

  - Caribbean
  - African
  - Any other Black background (Please write in below)

- Chinese or other ethnic group

  - Chinese
  - Any other ethnic group (Please write in below) Annex D: Combined survey results by age, sex and ethnic group

Background Results of the survey by the age, sex and ethnic group of respondents were last presented in the report for referrals made in March 2008(^1). That report compiled results for the first twelve surveys. These were aggregated for comparison, since the differences observed by age, sex and ethnic group were generally consistent over all the surveys and otherwise small samples for some groups made comparisons inconclusive. This annex updates that analysis by presenting the analysis of all sixteen surveys to date, combining these into groups of four successive surveys(^2).

Age and sex results The proportion of patients recalling being offered a choice of hospital for their first outpatient appointment was nearly 2% higher for women than for men, see Figure D.1 and Table D.2. The proportion also varied by age, although this became less marked as the general level of recall of choice rose. The highest proportion of patients offered choice was for 35-54 year olds and 55 to 64 year olds, whilst there were lower proportions for 16-34 year olds and those aged over 65.

Figure D.1 Percentage of patients offered choice by age and sex, combined survey results

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(^1) Report on the National Patient Choice Survey – March 2008 England, DH, September 2008

(^2) Surveys 1 to 4 are for referrals made in May/June, July, September and November 2006. Surveys 5 to 8 are for referrals made in January, March, May and July 2007. Surveys 9 to 12 are for referrals made in September and November 2007 and January and March 2008. Surveys 13 to 16 are for referrals made in May, July, September and December 2008. The proportion of patients aware before visiting their GP that they had a choice of hospital for their first outpatient appointment increased with age, see Figure D.2 and Table D.1. This trend was maintained across all the surveys to date, despite the general increase in awareness. Women generally had a greater awareness of choice, except in the over 65 age band where men had a greater awareness.

Figure D.2 Percentage of patients aware of choice by age and sex, combined survey results

The proportion of patients who were able to go to the hospital they wanted increased with age, whilst the proportion who had no preference decreased with age, see Figure D.3 and Table D.3. Men were somewhat less inclined to have a preference than women, slightly more of whom said they went to their hospital of choice.

Figure D.3 Percentage of patients going where they wanted or having no preference, by age and sex

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1 This question was introduced from the 10th survey (November 2007). Ethnic group results

The proportion of patients recalling being offered a choice of hospital for their first outpatient appointment was higher for patients in the White ethnic group than for Black and Minority Ethnic group (BME) patients(^1), see Figure D.4 and Table D.2. The Asian or Asian British and Black or Black British ethnic groups were on average 12% below the overall proportion of patients offered choice in the latest four surveys, as was the Other group (based on less than 0.5% of responses, see Table D.2). Those with Mixed ethnicity were slightly closer to average, whilst the Chinese group showed most variability and was not always below average (but also based on less than 0.5% of responses and omitted from Figure D.4). The variation by ethnic group lessened in the latest four surveys.

Figure D.4 Percentage of patients offered choice by main ethnic groups relative to the average, combined survey results

The proportion of patients aware before visiting their GP that they had a choice of hospital for their first outpatient appointment was higher for patients in the White ethnic group than for Black and Minority Ethnic group (BME) patients, see Figure D.5 and Table D.1. Of all BME patients, those considering themselves in the Mixed and Asian or Asian British groups had the highest awareness of choice. Nevertheless, awareness has risen over time across all groups.

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(^1) The results are weighted to adjust for age and sex bias amongst respondents to the surveys. However, no adjustment has been made for other factors that might affect the comparison by ethnic group, such as any correlation between the proportion of patients in different ethnic groups and geographic or deprivation effects. Separate study indicates that if we control for PCT-level effects, the main results are broadly consistent with those presented here. The proportion of patients who were able to go to the hospital they wanted was higher for patients in the White ethnic group than for Black and Minority Ethnic group (BME) patients, see Figure D.6 and Table D.3. All BME groups were less likely to have a preference of hospital than White patients (even when offered a choice).

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1 This question was introduced from the 10th survey (November 2007).

### Table D.1 Percentage of patients aware of choice by age, sex and ethnic group, surveys to date

| By age and sex: | Surveys 1 to 4 2006 | Surveys 5 to 8 2007 | Surveys 9 to 12 2007-08 | Surveys 13 to 16 2008 | May 2008 (13) | July 2008 (14) | September 2008 (15) | December 2008 (16) | |----------------|---------------------|---------------------|------------------------|-----------------------|---------------|------------------|---------------------|---------------------| | | Total | %Yes | Total | %Yes | Total | %Yes | Total | %Yes | | **Total** | 276,369 | 32% | 285,736 | 37% | 351,834 | 42% | 352,316 | 47% | | **By age and sex:** | | | | | | | | | | Male 16-34 | 18,601 | 23% | 19,237 | 27% | 22,851 | 31% | 20,237 | 36% | | 35-54 | 31,699 | 26% | 32,784 | 31% | 40,461 | 34% | 39,431 | 39% | | 55-64 | 19,124 | 34% | 19,779 | 38% | 24,479 | 43% | 24,004 | 50% | | 65+ | 35,105 | 40% | 36,306 | 45% | 44,885 | 50% | 43,896 | 56% | | **Total** | 107,761 | 32% | 111,677 | 37% | 134,298 | 41% | 128,169 | 46% | | Female 16-34 | 36,415 | 25% | 37,661 | 29% | 50,405 | 34% | 57,961 | 38% | | 35-54 | 51,872 | 32% | 53,647 | 36% | 68,115 | 41% | 70,646 | 47% | | 55-64 | 24,102 | 35% | 24,927 | 41% | 30,932 | 47% | 30,519 | 54% | | 65+ | 45,060 | 37% | 46,602 | 43% | 57,584 | 48% | 56,242 | 55% | | **Total** | 160,152 | 32% | 165,791 | 37% | 208,456 | 42% | 216,041 | 48% | | **By ethnic group:** | | | | | | | | | | White | 244,948 | 33% | 251,765 | 38% | 312,955 | 42% | 311,425 | 48% | | All BME | 24,138 | 26% | 26,237 | 30% | 30,925 | 34% | 33,661 | 39% | | Mixed | 3,430 | 28% | 3,605 | 31% | 7,648 | 36% | 10,373 | 42% | | Asian or Asian British | 10,655 | 26% | 12,049 | 32% | 12,489 | 35% | 12,555 | 39% | 3,281 | 37% | 3,567 | 39% | 3,084 | 39% | 2,622 | 40% | | Black or Black British | 5,986 | 25% | 6,236 | 27% | 7,297 | 32% | 7,732 | 35% | 1,998 | 34% | 2,177 | 35% | 1,967 | 34% | 1,591 | 39% | | Chinese | 1,192 | 26% | 1,309 | 30% | 1,340 | 31% | 1,323 | 36% | | Other | 2,874 | 29% | 3,038 | 31% | 2,151 | 31% | 1,678 | 37% |

1. Surveys 1 to 4 are for referrals made in May/June, July, September and November 2006. Surveys 5 to 8 are for referrals made in January, March, May and July 2007. Surveys 9 to 12 are for referrals made in September and November 2007 and January and March 2008. Surveys 13 to 16 are for referrals made in May, July, September and December 2008. For a breakdown by survey for surveys 1 to 12, see the Report on the National Patient Choice Survey – July 2007 England and the Report on the National Patient Choice Survey – March 2008 England.

2. Total valid responses. All figures are weighted, ie adjusted for national age and sex bias in the responding sample.

3. Percentage of patients who said Yes to Q1 ‘Before you visited your GP, did you know that you now have a choice of hospitals that you can go to for your first hospital appointment?’

4. Male and Female totals include those of unknown age. Overall totals also include those of unknown sex or ethnic group. Table D.2 Percentage of patients offered choice by age, sex and ethnic group, surveys to date

| By age and sex: | Surveys 1 to 4 2006¹ | Surveys 5 to 8 2007² | Surveys 9 to 12 2007-08³ | Surveys 13 to 16 2008⁴ | May 2008 (13) | July 2008 (14) | September 2008 (15) | December 2008 (16) | |----------------|----------------------|----------------------|--------------------------|------------------------|---------------|------------------|---------------------|---------------------| | | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | Total² %Yes³ | | Total | 276,369 35% | 285,736 45% | 351,834 46% | 352,316 46% | 89,903 45% | 93,528 46% | 93,003 46% | 75,878 46% | | By age and sex:| | | | | | | | | | Male | | | | | | | | | | 16-34 | 18,601 32% | 19,237 41% | 22,851 44% | 20,237 43% | 5,162 42% | 5,371 43% | 5,335 45% | 4,368 43% | | 35-54 | 31,699 36% | 32,784 46% | 40,461 45% | 39,431 45% | 10,050 45% | 10,468 44% | 10,399 45% | 8,514 46% | | 55-64 | 19,124 36% | 19,779 46% | 24,479 46% | 24,004 47% | 6,120 47% | 6,371 47% | 6,330 47% | 5,183 48% | | 65+ | 35,105 34% | 36,306 44% | 44,885 44% | 43,896 44% | 11,193 43% | 11,651 44% | 11,575 45% | 9,477 45% | | Total¹ | 107,761 35% | 111,677 45% | 134,298 45% | 128,169 45% | 32,694 44% | 34,028 45% | 33,790 45% | 27,658 45% | | Female | | | | | | | | | | 16-34 | 36,415 34% | 37,661 43% | 50,405 45% | 57,961 45% | 14,780 44% | 15,386 45% | 15,282 44% | 12,512 45% | | 35-54 | 51,872 39% | 53,647 49% | 68,115 49% | 70,646 49% | 18,015 48% | 18,751 49% | 18,628 49% | 15,252 49% | | 55-64 | 24,102 38% | 24,927 48% | 30,932 49% | 30,519 50% | 7,780 49% | 8,102 51% | 8,048 49% | 6,589 49% | | 65+ | 45,060 35% | 46,602 44% | 57,584 44% | 56,242 45% | 14,340 44% | 14,929 45% | 14,830 46% | 12,142 46% | | Total¹ | 160,152 36% | 165,791 46% | 208,456 47% | 216,041 47% | 55,114 46% | 57,342 47% | 56,968 47% | 46,617 47% | | By ethnic group:| | | | | | | | | | White | 244,948 36% | 251,765 46% | 312,955 46% | 311,425 47% | 79,095 46% | 82,511 47% | 82,256 47% | 67,563 47% | | All BME | 24,138 30% | 26,237 37% | 30,925 40% | 33,661 41% | 8,841 42% | 9,270 42% | 8,670 41% | 6,881 41% | | Mixed | 3,430 33% | 3,605 39% | 7,648 42% | 10,373 42% | 2,747 43% | 2,737 42% | 2,856 42% | 2,034 39% | | Asian or Asian British | 10,855 30% | 12,049 37% | 12,489 39% | 12,555 41% | 3,281 41% | 3,567 41% | 3,084 40% | 2,622 40% | | Black or Black British | 5,986 29% | 6,236 38% | 7,297 40% | 7,732 41% | 1,998 41% | 2,177 41% | 1,967 39% | 1,591 41% | | Chinese | 1,192 32% | 1,309 36% | 1,340 43% | 1,323 47% | 365 45% | 343 44% | 333 47% | 282 54% | | Other | 2,874 30% | 3,038 37% | 2,151 39% | 1,678 40% | 450 38% | 446 41% | 430 44% | 351 39% |

1. Surveys 1 to 4 are for referrals made in May/June, July, September and November 2006. Surveys 5 to 8 are for referrals made in January, March, May and July 2007. Surveys 9 to 12 are for referrals made in September and November 2007 and January and March 2008. Surveys 13 to 16 are for referrals made in May, July, September and December 2008. For a breakdown by survey for surveys 1 to 12, see the Report on the National Patient Choice Survey – July 2007 England and the Report on the National Patient Choice Survey – March 2008 England.
2. Total valid responses. All figures are weighted, ie adjusted for national age and sex bias in the responding sample.
3. Percentage of patients who said Yes to the question: ‘Were you offered a choice of hospital for your first hospital appointment?’
4. Male and Female totals include those of unknown age. Overall totals also include those of unknown sex or ethnic group. Table D.3 Percentage of patients able to go where they wanted by age, sex and ethnic group, surveys to date

| By age and sex: | Surveys 10 to 12 2007-08 | Surveys 13 to 16 2008 | May 2008 (13) | July 2008 (14) | September 2008 (15) | December 2008 (16) | |----------------|--------------------------|-----------------------|---------------|---------------|---------------------|-------------------| | | Total | %Yes | % No | Total | %Yes | % No | Total | %Yes | % No | Total | %Yes | % No | Total | %Yes | % No | | Male 16-34 | 16,632 | 61% | 30% | 20,237 | 62% | 28% | 5,162 | 61% | 28% | 5,371 | 62% | 28% | 5,335 | 62% | 27% | | | 39,431 | 63% | 27% | 10,050 | 62% | 28% | 10,468 | 62% | 27% | 10,399 | 63% | 26% | 8,514 | 65% | 26% | | | 24,004 | 67% | 23% | 6,120 | 66% | 24% | 6,371 | 67% | 22% | 6,330 | 67% | 23% | 5,183 | 69% | 21% | | | 33,147 | 70% | 21% | 43,896 | 70% | 21% | 11,193 | 69% | 21% | 11,651 | 69% | 21% | 9,477 | 71% | 20% | | | 98,165 | 66% | 24% | 128,169 | 66% | 24% | 32,694 | 65% | 25% | 34,028 | 65% | 24% | 27,658 | 67% | 23% | | Female 16-34 | 38,228 | 63% | 28% | 57,961 | 63% | 27% | 14,780 | 62% | 29% | 15,386 | 62% | 28% | 15,282 | 63% | 28% | | | 50,771 | 67% | 23% | 70,646 | 67% | 23% | 18,751 | 67% | 23% | 18,628 | 67% | 23% | 15,252 | 67% | 23% | | | 22,873 | 69% | 21% | 30,519 | 69% | 20% | 7,780 | 68% | 21% | 8,102 | 69% | 20% | 8,048 | 67% | 23% | | | 42,517 | 70% | 20% | 56,242 | 71% | 19% | 14,340 | 70% | 19% | 14,830 | 71% | 19% | 12,142 | 72% | 19% | | | 154,877 | 67% | 23% | 216,041 | 67% | 23% | 55,114 | 66% | 24% | 57,342 | 66% | 23% | 46,617 | 68% | 22% | | Total | 259,289 | 66% | 24% | 352,316 | 67% | 23% | 89,903 | 66% | 24% | 93,528 | 66% | 23% | 75,878 | 68% | 23% |

1. The question was introduced from Survey 10 (November 2007). For a breakdown by survey for surveys 10 to 12, see the Report on the National Patient Choice Survey – March 2008 England.
2. Total valid responses. All figures are weighted, ie adjusted for national age and sex bias in the responding sample.
3. Percentage of patients who said Yes or that they had No preference respectively to Q5 ‘Were you able to go to the hospital that you wanted to go to?’
4. Male and Female totals include those of unknown age. Overall totals also include those of unknown sex or ethnic group.